VBAC

WomanWise Midwifery and Einstein Medical Center Montgomery welcome women desiring a VBAC (Vaginal Birth After Cesearean).

BACKGROUND:
As long as you’re an appropriate candidate for a  VBAC, there’s a good chance you’ll succeed. Your chances of success are higher if the reason for your prior c-section isn’t likely to be an issue this time around.  At WomanWise Midwifery, our VBAC rate has ranged from 65 to 100 percent for the last 5 years.

Research shows that some women have a higher chance of a successful VBAC.  For example, a woman who has already had a vaginal delivery and then had a c-section when her next baby was breech is much more likely to have a successful VBAC than one who had a c-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned. (Having given birth vaginally boosts your odds dramatically.)

That said, it’s impossible to predict with any certainty which women will achieve a vaginal delivery and which will end up with a repeat c-section. Attempting a VBAC is called a Trial of Labor After Cesarean (TOLAC). Overall nationwide, about 60 to 80 percent of women who attempt a VBAC deliver vaginally.

According to the American College of Obstetricians and Gynecologists, you’re a good candidate for a vaginal birth after a c-section if you meet all of the following criteria:

  • Your previous cesarean incision was a low-transverse uterine incision rather than a vertical incision in your upper uterus (known as a “classical” incision) or T-shaped, which would put you at higher risk for uterine rupture.
  • You’ve never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.
  • You’ve never had a uterine rupture.
  • You have no medical condition or obstetric problem (such as a placenta previa or a large fibroid) that would make a vaginal delivery risky.
  • There’s an obstetrician on site who can perform an emergency c-section if necessary.
  • There’s an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.

Factors that would work against your having a successful VBAC include:

      • Being an older mom
      • Having a high body mass index (BMI)
      • Having a baby with a high birth weight (over 4,000 grams, about 8.8 pounds)
      • Having your pregnancy go beyond 40 weeks of gestation
      • Having a short time between pregnancies (18 months or less

PROTOCOLS FOR A TOLAC/VBAC
To provide the safest care possible for women undertaking a TOLAC, we strictly adhere to the following guidelines.  They have been formulated to ensure the best possible outcome for you and the baby, and put a priority on safety in case of an emergency, such as a uterine rupture. PLEASE NOTE: We can only accept patients who understand and agree to these protocols.

      • Upon arriving at the hospital in labor, all women will have an IV heplock inserted.  This will not necessarily be connected to IV tubing and an IV bag.
      • All women will have continuous fetal monitoring of their babies, while still being able to get out of bed, stand up, sit on the birth ball and use the squat bar.
      • The “deadline” for delivery is 41 weeks.  A cervical exam will be performed at 40 weeks — if a woman has a ripe cervix that will respond to pitocin, an induction will be offered.  If the cervix is unripe, a repeat c-section will be scheduled.

The Einstein Medical Center Montgomery VBAC consent form is available for review in the FORMS section of the website.  Please look it over.